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Musculoskeletal Function

G.J. is a 71-year-old overweight woman who presents to the Family Practice Clinic for the first time complaining of a long history of bilateral knee discomfort that becomes worse when it rains and usually feels better when the weather is warm and dry. “My arthritis hasn’t improved a bit this summer though,” she states. Discomfort in the left knee is greater than in the right knee. She has also suffered from low back pain for many years, but recently it has become worse. She is having difficulty using the stairs in her home. The patient had recently visited a rheumatologist who tried a variety of NSAIDs to help her with pain control. The medications gave her mild relief but also caused significant and intolerable stomach discomfort. Her pain was alleviated with oxycodone. However, when she showed increasing tolerance and began insisting on higher doses of the medication, the physician told her that she may need surgery and that he could not prescribe more oxycodone for her. She is now seeking medical care at the Family Practice Clinic. Her knees started to get significantly more painful after she gained 20 pounds during the past nine months. Her joints are most stiff when she has been sitting or lying for some time and they tend to “loosen up” with activity. The patient has always been worried about osteoporosis because several family members have been diagnosed with the disease. However, nonclinical manifestations of osteoporosis have developed.

Case Study Questions

Define osteoarthritis and explain the differences with osteoarthrosis. List and analyze the risk factors that are presented on the case that contribute to the diagnosis of osteoarthritis.
Specify the main differences between osteoarthritis and rheumatoid arthritis, make sure to include clinical manifestations, major characteristics, joints usually affected and diagnostic methods.
Describe the different treatment alternatives available, including non-pharmacological and pharmacological that you consider are appropriate for this patient and why.
How would you handle the patient concern about osteoporosis? Describe your interventions and education you would provide to her regarding osteoporosis.
Neurological Function:
H.M is a 67-year-old female, who recently retired from being a school teacher for the last 40 years. Her husband died 2 years ago due to complications of a CVA. Past medical history: hypertension controlled with Olmesartan 20 mg by mouth once a day. Family history no contributory. Last annual visits with PCP with normal results. She lives by herself but her children live close to her and usually visit her two or three times a week.
Her daughter start noticing that her mother is having problems focusing when talking to her, she is not keeping things at home as she used to, often is repeating and asking the same question several times and yesterday she has issues remembering her way back home from the grocery store.

Case Study Questions

Name the most common risks factors for Alzheimer’s disease
Name and describe the similarities and the differences between Alzheimer’s disease, Vascular Dementia, Dementia with Lewy bodies, Frontotemporal dementia.
Define and describe explicit and implicit memory.
Describe the diagnosis criteria developed for the Alzheimer’s disease by the National Institute of Aging and the Alzheimer’s Association
What would be the best therapeutic approach on C.J.

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Sample Answer

 

 

 

 

 

Case Study 1: G.J. – Osteoarthritis and Osteoporosis Concerns

1. Define osteoarthritis and explain the differences with osteoarthrosis. List and analyze the risk factors that are presented on the case that contribute to the diagnosis of osteoarthritis.

Osteoarthritis (OA) vs. Osteoarthrosis:

  • Osteoarthritis (OA): This is the more commonly used and preferred medical term. It refers to a chronic, progressive joint disease characterized by the breakdown of joint cartilage, leading to pain, stiffness, and reduced joint function. The “itis” suffix implies inflammation, and while inflammation is often a component of OA, it’s typically secondary to the mechanical breakdown and less systemic than in inflammatory arthritides like rheumatoid arthritis. OA is now understood as a whole-joint disease, involving not just cartilage but also the subchondral bone, synovium, menisci, ligaments, and periarticular muscles.
  • Osteoarthrosis: This term was historically used and is sometimes still preferred by some to emphasize the degenerative, non-inflammatory nature of the condition, particularly in its earlier stages. The “osis” suffix denotes a degenerative process without significant inflammation. However, given the growing understanding of the role of low-grade inflammation in OA pathophysiology, “osteoarthritis” is generally considered more accurate as the disease progresses and involves inflammatory processes.

Full Answer Section

 

 

 

 

 

In essence, “osteoarthritis” is the broader and more current term that acknowledges both the degenerative and often inflammatory aspects of the joint disease, while “osteoarthrosis” focuses purely on the degenerative component.

Risk Factors Presented in the Case Contributing to OA Diagnosis for G.J.:

Based on G.J.’s presentation, several significant risk factors for osteoarthritis are evident:

  1. Age (71-year-old female):
    • Analysis: Age is the strongest risk factor for OA. The cumulative wear and tear on joints, along with biological changes in cartilage and bone over time, increases the likelihood of developing OA. G.J.’s age of 71 falls squarely within the demographic where OA is highly prevalent.
  2. Overweight/Obesity (Gained 20 pounds in 9 months):
    • Analysis: Her current overweight status and recent 20-pound weight gain are significant contributors. Excess weight places increased mechanical stress on weight-bearing joints, particularly the knees. This chronic overloading accelerates cartilage breakdown. Adipose tissue also produces inflammatory mediators (adipokines) that can contribute to systemic low-grade inflammation, potentially worsening joint pain and cartilage degradation, even in non-weight-bearing joints.
  3. Gender (Female):
    • Analysis: Females, especially post-menopausal women, have a higher incidence of OA, particularly in the knees and hands. Hormonal factors (e.g., estrogen decline post-menopause) are thought to play a role, as estrogen has protective effects on cartilage.
  4. Specific Joint Involvement (Bilateral knees, left worse than right; low back pain):
    • Analysis: OA commonly affects weight-bearing joints (knees, hips, spine) and those used repetitively (hands). Her symptoms in both knees and her low back pain are characteristic distribution patterns for OA. The greater discomfort in the left knee suggests either more advanced disease or more consistent loading/stress on that particular joint.
  5. Pain Pattern (“worse when it rains,” “better when warm and dry,” “stiff when sitting or lying,” “loosens up with activity”):
    • Analysis: This is a classic symptomatic presentation of OA.
      • Weather Sensitivity: While the exact mechanism is debated, changes in barometric pressure and humidity associated with weather fronts are often correlated with increased joint pain in OA patients.
      • Morning/Rest Stiffness (Gelling Phenomenon): Stiffness after inactivity (e.g., “when she has been sitting or lying for some time”) that improves within 30 minutes with movement (“tend to loosen up with activity”) is a hallmark symptom of OA, differentiating it from inflammatory arthritis like RA where stiffness often lasts longer.
  6. Difficulty with Stairs:
    • Analysis: This indicates functional impairment directly related to her knee pain, a common consequence of moderate to severe knee OA, as stair climbing places significant stress on the patellofemoral and tibiofemoral joints.

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